Sarcoidosis Thomas, Karl W; Hunninghake, Gary W
JAMA : the journal of the American Medical Association,
06/2003, Letnik:
289, Številka:
24
Journal Article
Recenzirano
The symptoms, diagnosis, treatment, and prognosis of sarcoidosis are reviewed. Sarcoidosis is an inflammatory disease that causes lumps to form in various organs. These lumps are called granulomas ...and are most often formed in the lungs and lymph nodes. Despite years of study, no one knows exactly what causes sarcoidosis.
Fetal exposure to elevated levels of glucocorticoids can occur naturally when maternal glucocorticoids are elevated in times of stress or when exogenous glucocorticoids are administered. ...Epidemiological studies and animal models have shown that, whereas short-term benefits may be associated with fetal glucocorticoid exposure, long-term deleterious effects may arise. This review compares the effects of exposure to natural versus synthetic glucocorticoids and considers the ways in which the timing of the exposure and the sex of the fetus may influence outcomes. Some of the long-term effects of glucocorticoid exposure may be explained by epigenetic mechanisms.
It has been suggested that dexamethasone potentiates the sensory block produced by bupivacaine when both drugs are loaded in microspheres. The aim of the study was to evaluate the effect of ...dexamethasone on the brachial plexus block obtained with plain bupivacaine and bupivacaine-loaded microspheres.
Dexamethasone alone (Group 5) or added to plain bupivacaine (75 mg) with (Groups 3 and 4) and without pH correction (Group 2) was compared with plain bupivacaine (75 mg; Group 1). The effect of a small dose of dexamethasone (0.42 mg) was then evaluated on the brachial plexus block obtained with bupivacaine (750 mg) as bupivacaine-loaded microspheres (Group 6). Dexamethasone was added either in the suspending medium (Group 7) or incorporated with bupivacaine into microspheres (Group 8). The motor block was evaluated in a plexus brachial sheep model.
Dexamethasone alone did not produce any motor block. When added to plain bupivacaine without pH correction, complete motor block could not be obtained. When the pH was corrected, addition of dexamethasone to plain bupivacaine seemed to delay the onset of motor block and did not prolong its duration, and it had no effect on the pharmacokinetics of bupivacaine. With bupivacaine-loaded microspheres, the duration of complete motor block was reduced when a small dose of dexamethasone was added in the suspending medium. However, the duration of motor block was significantly prolonged when dexamethasone was incorporated with bupivacaine into microspheres.
Despite the delayed onset of motor block, the incorporation of dexamethasone in bupivacaine-loaded microspheres dramatically increases the duration of action (700 +/- 485-5160 +/- 2136 min), which could be clinically relevant when such a drug-delivery system will be available.
Patients with chronic obstructive airways disease and asthma are at special risk of developing osteoporosis. Previous research has indicated that adrenal androgen levels in postmenopausal women are ...suppressed by short term high dose inhaled corticosteroids. Such an effect, if sustained, may be a causative factor for long term bone loss. We tested the hypothesis that postmenopausal women receiving > or = 1 mg/day inhaled beclomethasone dipropionate, long term, have suppressed dehydroepiandrosterone sulphate levels when compared to postmenopausal controls.
As part of a larger study, we studied 36 postmenopausal subjects, recruited from regional pharmacies and a hospital chest clinic, who had been receiving treatment for asthma. Subjects were selected if they were receiving > or = 1 mg/day inhaled beclomethasone dipropionate (n = 27) or receiving no beclomethasone dipropionate (n = 9). The two groups were compared for dehydroepiandrosterone sulphate levels, age and potential confounders.
Mean dehydroepiandrosterone sulphate levels were 35% lower in the high dose beclomethasone dipropionate group than the control group (p < 0.01).
This is the first report of suppression of dehydroepiandrosterone sulphate in postmenopausal women receiving long term inhaled beclomethasone dipropionate. Further research is needed to clarify whether or not there is any associated clinically important adverse effect on bone density.
